Page 121 - 2022 Ranger Medic Handbook

Constipation / Fecal Impact
DEFINITION: Infrequent, hard, dry stools.
S/Sx: Recent history of infrequent passage of hard, dry stools or straining during defecation; abdominal pain, which is
typically poorly localized with cramping; if pain becomes severe and is associated with nausea/vomiting and complete
lack of flatus or stools, consider a bowel obstruction.
MANAGEMENT:
Generally, dietary modification to include increased fiber intake will resolve simple constipation conditions. First line is
30g dietary fiber daily along with 80–120oz of water.
1. If severe pain, rigid board-like abdomen, fever, and/or rebound tenderness develop, or moderate to large amounts of
blood are present in the stool, then treat per Abdominal Pain Protocol.
2. Polyethylene glycol 17g in 4–8oz of water PO qd titrated to effect.
3. If no relief, bisacodyl (Dulcolax) 10mg PO tid prn OR docusate 100mg PO bid. SECTION 3
4. If above measures fail, perform digital rectal examination to check for fecal impaction. If fecal impaction is present,
perform digital disimpaction, if trained.
5. Treat per Pain Management Protocol (no narcotics – they cause constipation). With all treatments, increase PO fluid
and fiber (fruits, bran, and vegetables) intake (both episodically and continuing lifestyle).
DISPOSITION: Evacuation is usually not required for this condition. Routine evacuation if no response to therapy.
SPECIAL CONSIDERATIONS: Differential diagnosis include acute appendicitis, volvulus, ruptured diverticulum, bowel
obstruction, pancreatitis, or parasitic infections. Acute onset, severe

Contact Dermatitis
DEFINITION: Skin reaction to external substance (plants, chemicals, topical medications, metals).
S/Sx: Acute onset of skin erythema and intense itching (pruritis); may see edema, papules, vesicles, bullae, discharge,
and/or crusting may be visible.
MANAGEMENT:
1. Remove offending agent and evaluate pattern.
2. Change clothes when possible and bag original clothes until they can be machine washed.
3. Wash area with mild soap and water.
4. Apply cold wet compress to affected area to help decrease itching.
5. If available, apply triamcinolone cream 0.1% (OR if on face, 1% hydrocortisone cream) to the affected area OR if
suspected poison ivy/oak/sumac, then Zanfel cream bid.
6. Give diphenhydramine 25–50mg PO/SL q6hr prn itching, if tactically feasible. (Sedation may occur.)
7. In severe cases (hands/feet/face/genital or > 30% BSA), prednisone 60mg PO daily × 5 days burst or taper dose
down every 3 days for 14- to 21-day course OR dexamethasone 10mg IM qd for 5 days OR methylprednisolone
125mg IM × 5 days.
DISPOSITION: Priority evacuation for severe symptoms: intraoral or eye involvement, or > 50% BSA involvement. Rou-
tine evacuation for any cases not showing improvement < 24 hours after steroids. Monitor for secondary infection; treat
per Cellulitis Protocol if suspected on the basis of increasing pain, redness, or purulent crusting.
SPECIAL CONSIDERATIONS:
1. Insect bite(s) as a differential diagnosis – also accompanied by itching, but with discrete red papular lesions(s).
2. Cellulitis as a differential diagnosis – bright red, painful, nonpruritic, and typically becomes steadily worse without
antibiotics.
3. Fungal infection as a differential diagnosis – not always pruritic; infection site(s) slowly enlarge without therapy.
4. Effects are particularly dangerous if contact in or around the eyes.

2022 RANGER MEDIC HANDBOOK 107